Daily Health Policy Report

Thursday, June 19, 2014

Last updated: Thu, Jun 19

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Women's Health

Coverage & Access

Health Care Marketplace

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Capsules: Future Uncertain For VA Rural Health Pilot Program

Now on Kaiser Health News’ blog, Kansas Public Radio’s Bryan Thompson reports: “Sen. Jerry Moran, R-Kan., said a U.S. Department of Veterans Affairs pilot program offering timely, quality health care to rural veterans is being allowed to expire in a few months, even as major legislation moves through both houses of Congress that would have similar goals as the pilot program. The pilot program is called Access Received Closer to Home, or ARCH. It’s offered at five sites — Pratt, Kansas; Caribou, Maine; Farmville, Virginia; Flagstaff, Arizona, and Billings and Anaconda, Montana. The program allows veterans to get health services from community providers if they live at least one hour from a VA health facility” (Thompson, 6/19). Check out what else is on the blog.

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Political Cartoon: 'Health Care Navigator?'

Kaiser Health News provides a fresh take on health policy developments "Health Care Navigator?" by Dan Piraro.

Meanwhile, here's today's haiku:

IT'S GETTING KIND OF SERIOUS...

Subpoenas issued
to find link between Hill staff
and Wall Street traders.
-Anonymous

If you have a health policy haiku to share, please send it to us at http://www.kaiserhealthnews.org/ContactUs.aspx and let us know if you want to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

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Health Reform

Insurers' 2015 Rate Filings Set Stage For Consumer Decisions

The Wall Street Journal notes that, as rates for the upcoming season shake out, consumers will make choices between paying higher premiums to stay on their current plans or switching coverage to save cash. Meanwhile, news outlets detail recent reports that analyze these costs, as well as the impact of federal subsidies, and offer regional takes on the rates.

The Wall Street Journal: Premiums Rise At Big Insurers, Fall At Small Rivals Under Health Law
Hundreds of thousands of consumers nationwide who bought insurance plans under the Affordable Care Act will face a choice this fall: swallow higher premiums to stay in their plan, or save money by switching. That is the picture emerging from proposed 2015 insurance rates in the 10 states that have completed their filings, which stretch from Rhode Island to Washington state. In all but one of them, the largest health insurer in the state is proposing to increase premiums between 8.5% and 22.8% for next year, according to a Wall Street Journal review of the filings. That percentage represents the average rate increases for all individual health plans offered by that carrier (Radnofsky, 6/18).

CQ Healthbeat: Premium Increases Forecast in 2015 for Health Law Exchange Plans
Monthly premiums for insurance in the new health law marketplaces will rise in eight of nine states studied in a new analysis released Wednesday by the Avalere Health consulting firm. Oregon was the only state to see a decrease. Average prices there will fall by 1.4 percent, or $3 per month. Among the nine states analyzed, Oregon has the lowest premium filed at $197 per month. Oregon’s average costs are lower, too: The average premium for popular silver-tier plans in 2015 will be $272 per month, compared to $466 per month in Vermont, which has the highest average costs (Adams, 6/19).

The Washington Post: Federal Insurance Exchange Subsidies Cut Premiums By Average Of 76%, HHS Reports
The Americans who qualify for tax credits through the new federal insurance exchange are paying an average of $82 a month in premiums for their coverage — about one-fourth the bill they would have faced without such financial help, according to a new government analysis. But the analysis shows wide variations among states in the premiums that people are paying for their new insurance, the amount the government is picking up and the proportion who qualify for the subsidies (Goldstein, 6/18).

The Associated Press: Delaware Subsidized Premiums Among Highest
Federal officials say Delawareans who are getting subsidies for health care insurance under the Affordable Care Act are getting an average monthly tax credit of $263. But figures released Wednesday also show that the 81 percent of enrollees in Delaware’s health insurance exchange are paying the third-highest average monthly premium in the country after tax credits are figured in (6/18).

Bridge Magazine: Obamacare Booms In Michigan, But Differences In Rates Raises New Questions
A few months into a critical phase of its rollout, the Affordable Care Act is on track to meet or exceed forecasts on two fronts in Michigan, enrolling residents in the individual marketplace and expanding Medicaid. If experts are right, it could cut the uninsured in Michigan in half by 2019. But on a third front – the insurance market competition – it might need a checkup. Rates in these rural counties are among the highest in the state, according to analysis by the Ann Arbor-based Center for Healthcare Research & Transformation (CHRT), a nonprofit partnership between the University of Michigan and Blue Cross Blue Shield of Michigan (Roelofs, 6/18).

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Health Law Causing Confusion For Consumers, Health Professionals

News outlets take a look at health law implementation challenges, including the difficulties that consumers are having in getting their coverage after enrolling and that the doctors' offices face when they attempt to confirm patients' new health plans. 

Huffington Post: Diagnosis: Headaches For Obamacare Enrollees At The Doctor's Office
Obamacare's enrollment glitches might have been fixed long ago, but they're still causing headaches at doctors' offices and clinics around the country. Patients and health care providers, in a series of interviews with The Huffington Post, complained that they are having trouble confirming that patients are insured, working out what their plans cover and figuring out which plans doctors will accept (Young, 6/18).

The Washington Post: District Residents Find Long Delays Getting Health Insurance From Private Plans
Consumers who signed up for private health insurance through the District's new insurance marketplace are experiencing lengthy delays in getting coverage, in some cases two to three months long, because of problems processing their applications, according to residents and enrollment personnel. In some cases, delays are forcing people without insurance to postpone doctor and dental visits (Sun, 6/18).

Also, a look at what fixes might cost -

The Washington Post's Wonkblog: What Would It Cost To 'Fix' Obamacare
You can't find an Obamacare supporter anywhere who thinks that the massive health-care law is problem-free. Any major law regularly gets fixed through the legislative process after it's passed, but the politics surrounding the Affordable Care Act has pretty much made this impossible so far. Democrats on the campaign trail have often talked about the need for fixing and improving Obamacare without really getting into specifics. That prompted conservative policy expert Chris Jacobs of America Next to recently wonder what these fixes would cost and how they'd be paid for. So I thought it would be a fun and useful exercise to round up Obamacare "fixes" that have garnered the broadest support and look at what they could potentially cost (Millman, 6/18).

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MNsure Review Finds Many Exchange Functions Do Not Work Properly

Minnesota's troubled online insurance marketplace faces major challenges after officials found this week that nearly two-thirds of functions on the site didn't work properly.

Pioneer Press: MNsure Knows How To Fix Broken Website
MNsure found out Wednesday how broken its website is and now plans to address the problems before the next big wave of people seeking health insurance hits in November. The consulting firm Deloitte told MNsure's board of directors that its review of the health exchange website's 73 components found that only 26 worked as expected (Snowbeck, 6/18).

Minnesota Public Radio: Contractor's Report Slams MNsure Weaknesses, Readiness
Minnesota faces major challenges in meeting the federal health care law's requirements for open enrollment this fall, the new general contractor for the state's online insurance marketplace told the MNsure board of directors on Wednesday. In a report to MNsure's board, representatives from Deloitte Consulting said if the troubled system makes improvements it is unclear if it will be ready in time for the next open enrollment period, which begins Nov. 15. The report found that MNsure could not reliably perform nearly two thirds, or 47 of 73, necessary functions, as they do not work properly or are non-existent (Catlin, 6/18).

The Star Tribune: MNsure Probe Finds 'System Gaps'
MNsure is still plagued by problems, with nearly two-thirds of its operating systems “absent or not functioning as expected,’’ and the glitches threaten fresh trouble for consumers during the coming fall enrollment period, the MNsure board was warned Wednesday. The assessment came from representatives of Deloitte Consulting in their first major report on MNsure’s operations since they were hired in April to help fix the health site’s problems. The consultants will present a more thorough analysis of medium- and long-term solutions in a follow-up report that could be presented at next month’s board meeting (Crosby, 6/19).

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Capitol Hill Watch

Administration Opened Marketplaces Despite Technology Concerns, GOP Senators Say

In new report, Sens. Orrin Hatch, R-Utah, and Charles Grassley, R-Iowa, allege the White House's delayed decisions kept health officials from meeting development deadlines for the online exchanges, Reuters reports. Meanwhile, a GAO official tells a Senate panel that the government has a flawed strategy on tech projects.

Reuters: Republicans Accuse Obama Administration Over Healthcare.gov Crash
Two Republican senators on Thursday issued a report accusing the Obama administration of pushing ahead with last October's botched rollout of HealthCare.gov website despite internal concerns that the technology would not work. The 34-page document, issued jointly by Senator Orrin Hatch of Utah and Senator Charles Grassley of Iowa, alleges that the White House prevented the U.S. Centers for Medicare and Medicaid Services (CMS) from meeting website development deadlines by delaying decisions on related regulations (6/19).

The New York Times: G.A.O. Tech Chief Says Washington Should Start Small On Big Projects
At a Senate hearing last week, David A. Powner, information technology director at the Government Accountability Office, said 183 of 759 federal technology contracts, worth about $10 billion, were in danger of failing before completion. In a separate interview, he laid much of the cause on an endemic need for government programs to think big. ... The most stunning example in recent memory, the HealthCare.gov insurance marketplace, speaks to that point. On Day 1, it was supposed to be both national and catering to anyone, using newer technologies with which many of the contractors did not have deep experience. "Was the project ever reviewed at an executive level while it was underway?" said Mr. Powner. "We didn’t see any evidence" (Hardy, 6/18).

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Congress' Desire For Quick VA Fix Complicated By Costs

Even as Senate and House negotiators are getting ready to try to forge a compromise on their bills, some members are raising concerns about the price tag that would come with an effort to let veterans who can't get timely appointments at the VA go to private doctors or hospitals.

Los Angeles Times: Fixing VA Mess Could Cost Billions, Complicating Congress Talks
The rush to fix the VA mess is running into an age-old Washington problem: where to find the money. Legislation to allow veterans facing long waits at Department of Veterans Affairs facilities to seek private healthcare could cost $50 billion or more a year, complicating efforts in Congress to swiftly come to agreement on a compromise bill (Simon, 6/18). 

The Washington Post: The Costs Of The Senate VA Bill
Three Republicans and at least one think-tank have opposed the bipartisan veterans affairs bill that passed the Senate with overwhelming support last week, saying the legislation was rushed to a vote before the costs were known. So what do we know about the measure's price tag? First, let’s look at the language of the bill. The provisions largely address the scheduling scandal within the Department of Veterans Affairs' health system, but they also expand certain benefits for former troops and their families (Hicks, 6/18).

Politico: House Creates VA Conference Committee
House and Senate lawmakers moved closer on Wednesday to new reforms to help fix problems with the Department of Veterans Affairs' medical facilities. The House approved legislation to convene a conference committee on the two VA-focused bills that would allow veterans to seek private care if they waited longer than a "standard" period of time for treatment. The bill would also give VA leadership the ability to fire department officials found to be involved with misconduct or who are under-performing (French, 6/18).

The Associated Press: VA Chief: More Vets Wait 30 Days for Appointment
About 10 percent of veterans seeking medical care at VA hospitals and clinics have to wait at least 30 days for an appointment -- more than twice the percentage of veterans the government said last week were forced to endure long waits, the acting veterans affairs secretary said Wednesday. Sloan Gibson said the higher number of veterans waiting 30 days or more is revealed in a report due out Thursday. He called the increase unfortunate, but said it was probably an indication that more reliable data was being reported by VA schedulers, rather than an actual increase in veteran wait times (Daly, 6/18).

Despite the efforts in Congress, a pilot program that offers some veterans access to private care faces an uncertain future.

Kaiser Health News: Capsules: Future Uncertain For VA Rural Health Pilot Program
Sen. Jerry Moran, R-Kan., said a U.S. Department of Veterans Affairs pilot program offering timely, quality health care to rural veterans is being allowed to expire in a few months, even as major legislation moves through both houses of Congress that would have similar goals as the pilot program. The pilot program is called Access Received Closer to Home, or ARCH. It’s offered at five sites -- Pratt, Kansas; Caribou, Maine; Farmville, Virginia; Flagstaff, Arizona, and Billings and Anaconda, Montana. The program allows veterans to get health services from community providers if they live at least one hour from a VA health facility (Thompson, 6/19).

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Insider-Trading Probe Involving Capitol Hill Staff And Medicare Policy Heats Up

The Wall Street Journal reports that prosecutors have issued grand jury subpoenas for evidence related to whether congressional staffers provided advance information to stock traders regarding a change in health care policy.

The Wall Street Journal: House Panel Is Subpoenaed As Trading Probe Heats Up
Prosecutors are gathering evidence for a grand-jury probe into whether congressional staff helped tip Wall Street traders to a change in health-care policy, an indication the long-running investigation has entered a more serious phase. Public documents show federal law-enforcement officials and the Securities and Exchange Commission are seeking records and other evidence from the House Ways and Means Committee and a top congressional health-care aide, Brian Sutter, staff director of the committee's health-care subpanel (Mullins and Ackerman, 6/18).

Reuters:  Officials Probe Possible Insider Trader Over U.S. Medicare Changes
Federal authorities and the U.S. Securities and Exchange Commission are seeking evidence for a grand jury investigation into whether congressional staff provided tips to Wall Street traders about a change in healthcare policy, the Wall Street Journal reported on Wednesday. The SEC sent subpoenas to the House Ways and Means Committee and Brian Sutter, staff director of the committee's healthcare subcommittee, the Journal said. The Justice Department also has subpoenaed Sutter to testify to before a grand jury in New York (6/18).

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Women's Health

High Court Decision Imminent On Health Law's Birth Control Mandate

Also pending is a decision regarding free speech arguments against a Massachusetts law that creates a buffer zone around abortion clinics to keep protesters from patients.

USA Today: Supreme Court Decisions Could Have Broad Impact
Fourteen of the court's 70 argued cases remain to be decided on topics ranging from abortion and contraception to Internet streaming and cellphone privacy. … A Massachusetts law creating 35-foot buffer zones around abortion clinics to keep protesters away from patients faces a potential First Amendment roadblock. The court upheld an 8-foot buffer zone in Colorado 14 years ago, but that was a close call. During oral arguments this winter, even liberal justices openly wondered if the Bay State had gone too far. … The court will decide whether for-profit companies with religious objections can be forced to offer coverage for contraceptives in their insurance plans.The case, brought by two corporations that equate certain birth control methods with abortion, threatens to become the first legal chink in the armor of the president's health care law. The court upheld the law in 2012 (Wolf, 6/19).

Meanwhile, a federal judge in Alabama dismissed a separate challenge to the birth control mandate -  

Associated Press:  Alabama Judge Rejects Claim Against Health Mandate
A federal judge in Alabama has dismissed a Catholic broadcaster's legal claim that requiring employers to include contraception in their health care coverage is unconstitutional. U.S. District Judge Callie Granade acted Wednesday on the lawsuit filed by the Eternal Word Television Network, which has studios in a Birmingham suburb (6/18).

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Coverage & Access

Cost And Quality Concerns Linger Over Baby-Boomer Long Term Care

Elsewhere, a California home care company weighs how new labor laws will affect their bottom line and industry.

NPR: How Your State Rates In Terms Of Long-Term Care
In just 12 years, the oldest members of the huge baby-boom generation will turn 80. Many will need some kind of long-term care. A new study from AARP says that care could vary dramatically in cost and quality depending on where they live. The study was motivated by a simple fact: The number of available family caregivers is declining. In 2010, there were potentially seven for each person 80 years old or older. By the time baby boomers reach that age, there will be only four potential caregivers for each of them. And those numbers are expected to continue declining. Chalk it up to longer lives and smaller families (Jaffe, 6/19).

The New York Times: Select Home Care Weighs New Wage And Labor Regulations
Select is confronting an array of regulatory changes. A federal rule will extend the minimum wage and overtime protections of the Fair Labor Standards Act to nonmedical caregivers when it takes effect in January. The company’s home state, California, has already enacted legislation that added a Domestic Worker Bill of Rights to the California Labor Code. Under the new guidelines, which went into effect Jan. 1, nonmedical home care employees are entitled to overtime pay for any more than 45 hours of work a week. In addition, California’s minimum wage will rise to $9 an hour on July 1. For home care companies like Select, these changes mean shorter shifts, more employees and higher wages (Chhabra, 6/18). 

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Health Care Marketplace

Experts Urge Business To Track Worker Health

A new group is urging businesses to improve the health of employees -- and says the move could save up to $30 billion a year in health care costs.

USA Today: Businesses Urged To Track Workforce Health
Out of frustration with decades of failed efforts to improve America's health and cut its health care spending, a new institute launched an effort Wednesday to attack the problem at work. The habits of working adults -- smoking, lack of exercise, unhealthy eating and high stress -- lay the groundwork for health problems years and decades later. Improving those health habits could dramatically reduce health care spending over the long term and make American workers more productive and competitive, said Derek Yach, executive director of the Vitality Institute for Health Promotion, a think-tank that aims to reduce non-communicable diseases such as heart disease, diabetes, mental illness and cancer (Weintraub, 6/18).

The Dallas Morning News: Commission Urges Firms To Report Employee Health Status
Companies should include employee health measures in their annual financial reports as part of a nationwide emphasis on preventive health care, an expert commission announced Wednesday. By informing shareholders of the health status of the workforce, companies can show how they emphasize improvements in productivity and innovation, the Vitality Institute Commission found. Healthier employees also mean lower health insurance costs. The commission estimated that acting on its recommendations would save the nation $22 billion to $30 billion a year in health care costs (Landers, 6/18).

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Insurers Face Difficult Cost And Coverage Calculations Regarding Gene-Sequencing Tests

Reuters: As Sequencing Moves Into Clinical Use, Insurers Balk
Aimee Robeson just wants an answer. Her son, Christian, was born in 2010 with multiple, mysterious syndromes that leave him unable to speak, chew, or walk on his own. Initial genetic tests failed to provide a diagnosis. Aimee's hopes are now pinned on a new test called exome sequencing that searches all the protein-making genes for glitches that could explain Christian's condition. Once strictly the domain of research labs, gene-sequencing tests increasingly are being used to help understand the genetic causes of rare disease, putting insurance companies in the position of deciding whether to pay the $5,000 to $17,000 for the tests (Steenhuysen, 6/19).

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State Watch

State Highlights: N.Y. Birth Control Discrimination Bill; Mich. Nursing Home Costs

A selection of health policy stories from New York, Michigan, New Jersey, Virginia, Maryland, North Carolina, California, Texas, Washington state, Missouri, Massachusetts and Colorado.

The New York Times: New York Legislature Reaches Deal On More Laws To Fight Heroin Problem
For the second time in two weeks, Gov. Andrew M. Cuomo gathered reporters on Wednesday to make an announcement about the state’s heroin problem, which has dominated discussions at the close of the legislative session in Albany. Last week, flanked by law enforcement officers, the governor was behind a lectern emblazoned with the words “Heroin Epidemic” (Goodman and McKinley, 6/18).

The Wall Street Journal: Deal Struck In Albany On Tackling Heroin Surge
Mr. Cuomo, a Democrat, cited statistics showing heroin's increasing share of the state's illegal drug market. Between 2004 and 2013, heroin and prescription-opiate treatment admissions in New York rose to 89,269 from 63,793, according to the state. The piece of the legislation with potentially the most immediate impact involves how insurance companies define treatment that is "medically necessary," a threshold used to determine whether to cover treatment. Advocates have complained that definitions of medical necessity differ among insurance companies and are applied unevenly (Orden, 6/18).

The Associated Press: N.Y. Assembly Passes Birth Control Insurance Bill 
A bill that would prevent employers from discriminating against workers for reproductive health decisions has passed the Democratic-led Assembly. The "Boss bill," passed 80-22 on Wednesday, seeks to close a loophole in New York's anti-discrimination laws (6/19).

Detroit Free Press:  Nursing Home Care Now Costs More Than Twice Seniors’ Average Income
The annual cost of nursing home care may have grown even less affordable to Michigan’s seniors and people with disabilities, now costing families about $93,075 -- more than 2 1/2 times older adults’ average income of $35,504, according to a new report. The drastically outsized cost of care compared to income -- 262 percent in Michigan -- is staggering elsewhere as well. The national average was 246 percent in 2013 compared to 241 percent in 2010, according to the report, Raising Expectations, a joint venture between the Commonwealth Fund, a health research foundation, and two advocacy groups for older adults, the Scan Foundation and AARP (Erb, 6/18).

Asbury Park Press/USA Today: Report: Sandy Left Mental Health Issues In Its Wake
What had long been predicted in the immediate aftermath of Sandy is finally appearing in the data research: More individuals in the 10-county area affected by Sandy in New Jersey are seeking help for behavioral health concerns such as alcohol and substance abuse, sleep disturbances, anxiety, depression and post-traumatic stress disorder (Cervenka, 6/18).

The Washington Post: McDonnell Reflects On Cantor’s Loss, Gillespie’s Chances At GOP Gathering In Va.
Romney also endorsed Gillespie, who he said dropped everything to work for his 2012 presidential bid, and slammed Warner over taxes, Obamacare and foreign policy. … Gillespie made a pitch for doubling the nation’s economic rate, although he provided no specifics. “We know that our policies will create jobs and raise take-home pay and hold down health care costs and reduce energy prices,” he said, adding later: “Instead of having a blank check for President Obama, we can have a check on President Obama” (Portnoy, 6/18).

Baltimore Sun: Closing Of Health Centers Causes Patients To Scramble
When Will Boyd arrived Wednesday at the People's Community Health Center's Brooklyn Park clinic, he was furious to learn that the center will close at the end of the month. The 63-year-old has two broken teeth needing repair and said he was told he couldn't be helped there. "This is not a way to take care of people when they've got pain," said the Brooklyn Park resident. Local and state health officials are scrambling to find alternate health care providers for People's 1,100 low-income clients after the Baltimore-based nonprofit announced this week that it will close its five centers in Baltimore and Anne Arundel County (Wood and Cohn, 6/18).

North Carolina Health News: Health Care Issues Among Flurry Of Last-Minute Bills 
Wednesday’s regulatory and reform committee meeting showed how political maneuvering can get special interests sneaked into an omnibus, vaguely described bill during the short session, which is supposed to focus on the state budget and bills leftover from last year (Namkoong, 6/19).

Reuters: California Bill Would Restore Funding For Adult Day Care Centers 
California lawmakers advanced a bill on Wednesday that would restore adult day care services as a benefit under Medi-Cal, the state's health insurance program for low-income and disabled residents. The program, which provides a variety of healthcare and social services to people with disabilities, was cut during the state's budget crisis in 2011, but is one of several pieces of the state's tattered safety net Democrats have been pushing to restore (Chaussee, 6/18).

Houston Chronicle: Nursing Home Scorecard Dings Texas For Staff Turnover 
A national report ranks Texas last for nursing home staff turnover -- one of the quality of care issues that directly impacts the safety and well-being of nursing home residents. Overall, Texas ranked 30th among the states and the District of Columbia, improving slightly from its No. 32 ranking in the report’s first edition, which was released in 2011 (George, 6/19).

Texas Tribune: Texas Parents Find Access To Medicaid Without Expansion
Texas' Republican leadership made sure the state didn't expand its Medicaid program to poor, uninsured adults — an optional provision of the Affordable Care Act. But low-income parents here are increasingly getting covered by the joint state-federal insurer anyway — through the Temporary Assistance for Needy Families program. ... The Texas Health and Human Services Commission estimates that more than 140,000 adults received Medicaid through their TANF eligibility in May — a 21 percent increase over November (Ura, 6/19).

Seattle Times: Seattle Children’s Argues In Favor Of Rulings By Embattled OIC Judge
Seattle Children’s hospital on Tuesday made another move in the high-profile legal tussle over which facilities and doctors must be included in insurance plan networks in order to adequately protect customers. The case -- already significant because of the importance of the network adequacy debate -- became even more controversial following allegations that the judge overseeing the dispute has been unfairly influenced. The allegations came from the judge herself, Patricia Petersen, chief presiding officer at the Office of the Insurance Commissioner (Stiffler, 6/18).

St. Louis Post-Dispatch: UnitedHealthcare Cuts Missouri Physicians From Medicare Advantage
UnitedHealthcare has notified more physicians in Missouri that they will be removed from the company’s Medicare Advantage plan on Sept. 1. This is the second round of cuts to UnitedHealthcare’s Medicare Advantage physician ranks, following reductions in April. The provider is the largest carrier of Medicare Advantage plans for seniors in the nation, with about 95,000 plan members in Missouri (Kulash, 6/19).

Modern Healthcare: Massachusetts Medical Society Opposes Nurses Initiatives 
The Massachusetts Medical Society is opposing two initiatives developed by the Massachusetts Nurses Association that would designate nurse-patient staffing ratios and would impose penalties on hospitals whose profit margins go above 8 percent and whose CEOs' annual compensation exceeds 100 times the compensation offered the hospital's lowest-paid employee. Dr. Richard Pieters, MMS president, said in a news release that healthcare institutions can assume that they will be receiving no additional state and federal funding, so increasing nurse staff would mean personnel would be cut elsewhere. Pieters added that the other measure was unnecessary and its proposed limits and penalties arbitrary (Robeznieks, 6/18).

Health News Colorado: Doctor Shortages Accelerate As Patients Pour In For Care
Newly insured patients are pouring into Colorado’s safety net clinics, but in some cases, sparkling new exam space sits empty because there aren’t enough doctors to care for the influx of patients. The Metro Community Provider Network (MCPN) this month celebrated its first anniversary at a large new state-of-the-art clinic in Wheat Ridge, the newest of its 22 locations in the Denver area. One pod is ready to serve older patients and those with mobility issues. Extra wide “barn” doors allow easy access for people in wheelchairs and there’s a special spot to park walkers and other devices for people with special needs (McCrimmon, 6/18). 

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Weekend Reading

Longer Looks: Caregiver's Effort To Stay Well; Views On Postpartum Depression

Every week KHN reporter Marissa Evans finds interesting reads from around the web. 

Minnesota Public Radio: How A Caregiver Learns To Care For Herself: Living With ALS
More than 65 million people, or 29 percent of the U.S. population, provide care for a chronically ill, disabled or aged family members or friends during any given year, and spend an average of 20 hours per week providing that care. And more than three in 10 U.S. households, or 31.2 percent, report that at least one person has served as an unpaid family caregiver, according to AARP. That means that even if you aren't a caregiver now, it's likely that you will be someday. Ev Emerson, the wife of Bruce Kramer, teaches music at the Normandale Elementary French Immersion School in Edina, and is also looking after her husband after he was diagnosed with ALS. He was worried when he was first diagnosed about the effect his illness would have on his wife and their relationship, along with the rest of family (Cathy Wurzer, 6/15).

The Atlantic: When Patients Are Counting On Miracles
If the idea of a "miracle" feels out of place anywhere, it's in hospital waiting rooms. The sterile experience of getting an IV and wearing a scratchy paper gown and being surrounded by neutral landscape paintings can obscure the intense, emotional questions tangled up in sickness: Why do bodies break down the way they do? Why do some people get sick while others stay healthy? And if doctors can't save someone, can God? A lot of people do seem to think so. In a 2008 study published in the Archives of Surgery, 57 percent of non-medical workers said they thought divine intervention could save a sick family member, even if doctors said further treatment would be useless (Emma Green, 6/18). 

Esquire Magazine: I Lived Through The Most Nerve-Wracking Birth Story You May Ever Read
We'd come seven hundred miles in the gut of winter because my wife's perinatologist recommended we meet with prenatal specialists at Children's Hospital Colorado. He also told us that he had started his own practice twenty years earlier and delivered sets of quads, but he'd never encountered a pregnancy like ours: triplets, with a pair of monoamniotic and monochorionic twins residing together in a single sac. That sac had become a fetal rugby scrum of elbows and feet and umbilical cords twisted into a knot that would, in time, compress and cut off the twins' blood supply. They grew with a constant threat of sudden death. We had come to Colorado to decide if we should let them go (Tim Paluch, 6/13).  

The New York Times: An Alert When The Policy Lapses
Michael Pirron is feeling pretty good these days. In January, I reported the sad tale of his elderly parents, whose confusion allowed their long-term care insurance to lapse. Though Anne and David Pirron had faithfully paid John Hancock about $50,000 in premiums over 11 years, which would have entitled them to about $600,000 in benefits through their joint policy, the elder Mr. Pirron had gone to his bank and mistakenly stopped the auto-payment system his son had set up.When John Hancock sent notices that their coverage was about to end because they’d stopped making payments, the Pirrons didn’t know what to do with them and stashed them in a drawer. Their son found the letters months later, when his mother needed more care and he wanted to tap their benefits (Paula Span, 6/12). 

The New York Times: 'Thinking Of Ways To Harm Her'
Postpartum depression isn't always postpartum. It isn't even always depression. A fast-growing body of research is changing the very definition of maternal mental illness, showing that it is more common and varied than previously thought. Scientists say new findings contradict the longstanding view that symptoms begin only within a few weeks after childbirth. In fact, depression often begins during pregnancy, researchers say, and can develop any time in the first year after a baby is born (Pam Belluck, 6/15).

Modern Healthcare: Obamacare Rule Has Hospitals Targeting Health Improvement
When 193-bed Advocate Trinity Hospital began five years ago to assess the health needs of residents in its service area on Chicago's South Side, it found the rate of stroke was among the highest in Illinois. Deaths from heart disease and cancer made up half of the more than 2,700 deaths that occurred in the hospital's service area in 2011. "We mapped out a plan of what those (health) gaps were," said Michelle Gaskill, president of Trinity. "Then we started identifying investments we were going to make over a period of time to start filling those gaps." ... All not-for-profit hospitals are now required by the Patient Protection and Affordable Care Act to conduct and publish similar community needs assessments once every three years. They also must draft a strategic plan on how they will address identified needs (Steven Ross Johnson, 6/14).

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Editorials and Opinions

Viewpoints: The Cost Of A VA Fix; Virginia GOP 'Must Be So Proud'; Health Law Critics' Argument Backfires

The Wall Street Journal: The Second VA Scandal
The Veterans Affairs scandal has exposed a failing bureaucracy, so naturally Congress's solution is to give the same bureaucracy more money. The underreported story is that taxpayers could end up paying $50 billion each year so Congress can claim to have solved the problem (6/18). 

The Huntsville Times/Alabama.com: Does Alabama Already Have A Better Healthcare Model Than The Medicaid Expansion?
Governor Bentley has called the ACA Medicaid expansion "a federal government dependency program for the uninsured." On the other end of the political spectrum, Democratic gubernatorial candidate Parker Griffith claims that growing Medicaid will generate "30,700 new jobs, [a] $2.1 billion economic boost, plus 500 lives saved every year." If even the most ardent proponent of the Medicaid expansion in Alabama advocates the economic stimulus of the ACA Medicaid expansion ahead of improving healthcare outcomes, the debate over Medicaid has clearly become more about money and politics than helping vulnerable Alabamians (Cameron Smith, 6/18).

The Virginian-Pilot: Dear State GOP: Your Medicaid "Win" Is A Loss For A Lot Of Hard-Working Folks
Congratulations, Republicans in the state General Assembly. You've beaten back attempts to provide health care to as many as 400,000 lower-income, uninsured residents in the commonwealth. You must be so proud. ... During this months-long debate, you've shown no inclination for compromise. You've sought additional study of Medicaid in Virginia, even though state officials say the program has been audited more than 50 times over the past decade. Hey, if Obamacare was changed to -- say, Romneycare, on which it is based -- would you change your mind? Just wondering (Roger Chesley, 6/19). 

The New Republic: This Is What It Looks Like When An Obamacare Attack Backfired
Some House Republicans on Wednesday set out to make Obamacare look bad. They ended up making it look good. It happened at a hearing of the Oversight Committee. The subject was the Affordable Care Act's "shock absorbers"—programs called risk corridors, reinsurance, and risk adjustment through which insurance companies can collect government subsidies if they lose large sums of money. ... it turns out that the insurers provided some other information. The House Republicans didn't talk about it, but Democrats on the committee did. The additional data was about enrollment by age—what the insurers expected to get, and what they actually got. It turns out that enrollment among 18-to-34 year olds actually exceeded expectations, both in absolute and relative terms (Jonathan Cohn, 6/19).

The Fiscal Times: Why Health Care Is Still A Winning Sector
The irrefutable expansion of American health care has been a boon to investors, who have been reaping the benefits in stocks, mutual- and exchange-traded funds in the sector. Health care stocks have outperformed the S&P 500 Industrial Index over the last three and five years and continue to outpace the broad-based average (John F. Wasik, 6/19).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Lisa Gillespie
Shefali Luthra

The Kaiser Daily Health Policy Report is published by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. (c) 2014 Kaiser Health News. All rights reserved.